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Tennessee

INTRODUCTION

Currently, about 1.9 million people are living with limb loss in the United States. People lose their limbs for many reasons. Of the 1.9 million, 54 percent lost their limb(s) due to complications related to vascular disease (including diabetes and peripheral arterial disease), 45 percent lost their limb(s) due to a traumatic accident, and less than 2 percent had an amputation due to cancer. Non-whites make up about 42 percent of the limb loss population in the United States. The number of people living with limb loss in the country is expected to double by 2050 due to growing rates of diabetes and vascular disease (1).

Each year, an estimated 185,000 amputations are performed in the United States (2). The leading causes of amputation in adults are vascular disease (including complications related to diabetes and peripheral arterial disease), trauma and cancer. According to the Centers for Disease Control and Prevention, in 2009 there were 68,000 amputations due to complications from diabetes (3).

A total of 3,475 amputations were performed in Tennessee hospitals in 2012. This fact sheet discusses the trends and most current incidence of amputation in Tennessee.

1. AMPUTATION TRENDS (2001 – 2012)

According to national hospital discharge data, the number of amputations performed in Tennessee decreased by 8 percent from 2001 to 2012 (see Graph 1.1). During this time period, the number of amputations performed in the United States increased by 0.1 percent.

A total of 42,941 amputation procedures were performed in Tennessee from 2001 to 2012. This represents 2.5 percent of the 1,707,134 amputation procedures performed in the U.S. during this time period.

From 2001 to 2012, a total of 3,067 upper-limb amputation procedures were performed in the state of Tennessee (see Graph 1.2). This represents 7.1 percent of all amputations performed in the state in this time period.

From 2001 to 2012, 162,382 upper-limb amputations were performed in the United States. The number of upper-limb amputations performed in Tennessee represents 1.9 percent of this national total.

The incidence of upper-limb amputations in Tennessee increased 2.5 percent in these years. The leading causes of upper limb loss are trauma, cancer, and congenital anomaly (1, 4, 5).

From 2001 to 2012, the number of lower-limb amputations in Tennessee decreased by 8.9 percent (see Graph 1.3). A total of 39,575 lower-limb amputation procedures were performed in Tennessee during these years. This represents 92.2 percent of all amputation procedures performed in the state.

From 2001 to 2012, 1,584,020 lower-limb amputations were performed in the United States. The number of lower-limb amputation procedures performed in Tennessee represents 2.5 percent of this national total.

The leading causes of lower-limb amputation are complications resulting from dysvascular diseases such as diabetes, and the number of people who lose a limb due to diabetes is expected to almost triple by the year 2050 (1, 4).

2. INCIDENCE OF AMPUTATION (2012)

A total of 3,475 amputation procedures were performed in the state of Tennessee in 2012, including 242 upper-limb amputations (7 percent) and 3,202 lower-limb amputations (92.1 percent).

Most upper-limb amputations involved the fingers (75.2 percent), followed by below-elbow amputations (9.5 percent). Amputations of the thumb accounted for 8.7 percent, while above-elbow amputations accounted for 6.6 percent of all upper-limb procedures performed in the state of Tennessee in 2012 (see Graph 2.1).

A total of 3,202 lower-limb amputations were performed in 2012. Almost half involved the toes (43 percent). Below-knee amputations accounted for 23.2 percent and above-knee accounted for 19.8 percent of the lower-limb amputation procedures performed in the state in that year (see Graph 2.2).

3. WHO LOSES A LIMB? (2012)

In 2012, almost half of the amputations in Tennessee were performed on individuals aged 45-64 years old (47 percent), followed by the age group of 65-84 year olds (34.1 percent) (see Graph 3.1). These trends largely reflect the aging population, and cases of amputations resulting from dysvascular conditions, especially diabetes, which are more common in older individuals (1).

There were 2 times more amputations performed on male patients in Tennessee than on female patients (see Graph 3.2).

In 2012 most amputations in the state of Tennessee were performed on patients who were White (77 percent) or African American (19.7 percent) (see Graph 3.3).

Many studies have published research that shows evidence for inequalities in terms of amputation incidence among minorities when compared to the proportion of amputations in the White population. A few studies offer suggestions for why this happens, such as certain ethnic populations being genetically more likely than others to experience diseases such as diabetes that can lead to amputation. Various socioeconomic factors and a population’s access to healthcare can also affect these numbers. (4, 6, 7)

4. AMPUTATION COSTS

Paying for an amputation can place a large burden on the patient. For people with a unilateral lower-limb amputation, the two-year healthcare costs, including initial hospitalization, inpatient rehabilitation, outpatient physical therapy, and purchase and maintenance of a prosthetic device, is estimated to be $91,106. The lifetime healthcare cost for people with a unilateral lower-limb amputation is estimated to be more than $500,000 (8).

Many factors contribute to the variation in healthcare costs for people with limb loss. Having a higher amputation level and multiple amputations can lead to increased costs for prosthetic devices. For example, the two-year healthcare costs for a person with an above-knee amputation are estimated to be $110,039, compared to $86,244 for a person with a below-knee amputation (8).

For 2012, the burden of costs associated with limb loss were largely experienced by Medicare, which paid for over half of the amputation procedures performed in the State of Michigan (see Graph 4.1).

8. MacKenzie EJ. Health-Care Costs Associated with Amputation or Reconstruction of a Limb-Threatening Injury. The Journal of Bone and Joint Surgery (American)2007;89(8):1685.

It is not the intention of the Amputee Coalition to provide specific medical or legal advice but rather to provide consumers with information to better understand their health and healthcare issues. The Amputee Coalition does not endorse any specific treatment, technology, company, service or device. Consumers are urged to consult with their healthcare providers for specific medical advice or before making any purchasing decisions involving their care.

National Limb Loss Resource Center, a program of the Amputee Coalition, located at 900 East Hill Ave., Suite 390, Knoxville, TN 37915 | 888/267-5669

This Web site was supported, in part, by grant number 90LL0002-03-00 and 90LL0002-03-01, from the Administration for Community Living, U.S. Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.